Glaucoma is known as the "silent thief" of sight because it steals your vision often without warning signs or symptoms. In fact, nearly 2.5 million people have glaucoma and more than half don't even realize it.
Glaucoma is a disease that damages the optic nerve. Like a cable wire, the optic nerve is responsible for carrying the images we see to the brain. Damage to the optic nerve can occur when pressure within the eye increases, usually due to a buildup of fluid inside the eye. This leads to the development of blind spots in our field of vision. Without routine eye exams to check the health of your eyes, these blind spots can go undetected until the optic nerve is significantly damaged and a great loss of peripheral vision has already occurred.
Types of glaucoma – Not every type of glaucoma is the same or will have the same impact on your life. If you have been diagnosed with glaucoma, please familiarize yourself with the different types of glaucoma below.
Open-angle glaucoma – This is the most common type of glaucoma. The drainage angle (where the fluids in the eye drain) is open but working less efficiently. This inability to drain causes pressure within the eye to rise, which results in a gradual loss of side vision. This can be likened to an air filter, which gathers dust over time and eventually becomes too laden with dust to work properly.
Angle-closure glaucoma – Angle-closure glaucoma occurs when the drainage angle is completely blocked, often by the iris. This prevents any fluid to drain from the eye, causing pressure within the eye to suddenly rise. This extreme rise in pressure results in blurred vision, headaches, severe eye pain, and the appearance of halos around lights.
Chronic angle-closure glaucoma – With this type of glaucoma, the condition is painless and involves a more gradual closing of the drainage angle. Chronic angle-closure glaucoma occurs most frequently in people of Asian descent.
Secondary glaucoma – Secondary glaucoma progresses very much like chronic open-angle glaucoma, occurring when scar tissue or pigment blocks the drainage angle. The first symptom is a loss of side vision. Pseudoexfoliation glaucoma and pigment dispersion glaucoma are examples of secondary glaucoma.
Congenital glaucoma – Congenital glaucoma is a rare birth defect affecting the drainage angle. To prevent blindness, this condition must be treated shortly after birth. Symptoms include enlarged eyes, a cloudy cornea, light sensitivity, and excessive tearing.
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WHO IS AT RISK FOR GLAUCOMA?
Since glaucoma can affect any adult regardless of gender or race, it is important to receive regular, comprehensive eye examinations as directed by your eye care provider. There are certain factors that can increase your risk, such as:
- Being 45 years or older
- Having increased eye pressure
- Having a family history of glaucoma
- If you are severely nearsighted
- Being of African-American, Hispanic, or Asian descent
- Having a history of eye injuries causing bleeding in the eye
Although patients can be nervous about a new diagnosis of glaucoma, it is important to keep a positive attitude. Glaucoma does not have to limit your lifestyle, and for the most part, you should be able to continue with your regular habits and activities.
Glaucoma needs to be taken seriously now more than ever. Although glaucoma is the second leading cause of blindness in the U.S. and can be extremely problematic to your vision, most people with glaucoma lead a normal life.
If you've been diagnosed with glaucoma, your eye doctor will make a suggested treatment protocol based on taking medication, laser treatment, or surgery.
At Vance Thompson Vision, we are proud to perform the state-of-the-art MIGS (minimally invasive glaucoma surgery), which continues to change the lives of our patients.
Additional treatment options for glaucoma include:
Glaucoma can be treated with daily eye drops that decrease eye pressure either by slowing the amount of fluid produced within the eye or by improving the flow through the drainage angle. Glaucoma medications may have side effects so be sure to talk to your doctor if you experience any unusual symptoms.
Selective Laser Trabeculoplasty (SLT) is a good in-office treatment option for glaucoma that is completely painless. By engaging in this laser technology, ophthalmologists can lower pressure and possibly help a patient avoid a more invasive surgery. The surgery may even reduce dependence on medications or drops.
In a standard operating room procedure, your doctor can also use fine, microsurgical instruments to create a new drainage channel for outflow of aqueous fluid. Though serious complications of modern glaucoma surgery are uncommon, they can occur. Surgery is recommended if your ophthalmologist feels that it is necessary to prevent further damage to the optic nerve. Before considering surgery, it is important you visit a qualified surgeon who can educate you about all of your surgical options. Vance Thompson Vision’s glaucoma surgeons specialize in glaucoma treatment, which reduces the need for eye drops. This ensures that you will know all of your options prior to surgery and can choose the best option for your vision and lifestyle.
Trabeculectomy & Tube Shunts
Trabeculectomy and tube shunt procedures are performed by an ophthalmologist and can lower the pressure in your eye to help prevent further damage to the optic nerve. However, any damage that has already been done is irreversible.
During a trabeculectomy or tube shunt, your surgeon creates a passageway that drains fluid from the inside of your eye to behind it. These surgeries are more commonly used after medications have not worked as planned, if laser surgery has not been effective, or if other methods of treatment, such as the Glaukos iStent are simply not stopping the increase in intraocular pressure.
Although patients can be nervous about a new diagnosis of glaucoma, it is important to keep a positive attitude. Glaucoma does not have to limit your lifestyle, and for the most part, you should be able to continue with your regular habits and activities. Take comfort in knowing that many individuals, including our doctors, are stepping up to help glaucoma research initiatives. The eye care community, including the Glaucoma Research Foundation, surges forward in an effort to find better methods to treat glaucoma. Someday, there may even be a cure for this disease.
Minimally Invasive Glaucoma Surgery (MIGS) is a tremendous recent advance in glaucoma care. Prior to MIGS, treatment options were limited to medications, laser, and major glaucoma surgeries. Using devices like the Glaukos iStent, MIGS provides a less invasive and very safe surgical approach to glaucoma surgery. MIGS is usually, but not always, performed at the same time as cataract surgery in patients with mild to moderate glaucoma. The iStent is the smallest medical device ever implanted into humans and is used to decrease eye pressure by internally bypassing the high resistance portion of the eye’s drainage system. The iStent was approved by the FDA in the summer of 2012 and is the most thoroughly studied glaucoma device on the market today. Other MIGS include:
- KDB: The Kahook Dual Blade (KDB) is an elegant, single-use ophthalmic blade designed to excise a clean strip of trabecular meshwork. It can be a standalone procedure or performed in combination with cataract surgery in patients with mild to moderate glaucoma.
- ABiC: Ab-Interno Canaloplasty (ABiC) is a procedure designed to improve the natural drainage in the eye. In the ABiC procedure, the surgeon inserts a microcatheter into the eye through a tiny incision and then rotates the tool to open up the entry point. The surgeon then inserts gel into the canal, which enlarges the drainage area. Through this surgery, the doctor increases and restores the eye’s natural outflow passage. By improving the drainage pathway, fluid can drain more normally and allow the eye pressure to lower.
- ECP: Endoscopic cyclophotocoagulation (ECP) is a procedure used to treat glaucoma that applies laser energy to the ciliary body epithelium in an effort to lower eye pressure. ECP’s initial studies have shown it to be more promising than its predecessors. Its advantages consist of precise tissue treatment, short surgical times, rapid postoperative recovery, and reduced complications.
- XEN Gel Stent: The XEN Gel Stent is a soft, gelatinous device inserted into the eye to decrease the eye’s intraocular pressure (IOP). The stent is designed to treat glaucoma with a less invasive procedure with fewer complications than traditional glaucoma treatments. The stent is about as wide as a human hair and it is 6mm long. The device is inserted through a small corneal incision intended to seal itself.
- iStent: The iStent Trabecular Micro-Bypass Stent is the smallest FDA-approved implantable device, measuring only 1mm by.3mm. The iStent is a tiny device placed in the eye to improve fluid drainage. It creates a pathway through the eye, which helps fluid drain naturally from the eye (in turn, lowering intraocular pressure). The iStent is generally implanted during cataract surgery.
- Visco360: When the aqueous fluid is low in the Schlemm's canal, the Visco360 cannula can be inserted through a single incision to inject viscoelastic fluid (through a microcatheter) into the cornea. This technique will help decrease intraocular pressure on the optic nerve with the addition of controlled volumes of viscoelastic fluid.
- Ex-PRESS Mini Shunt: In some cases, your surgeon may suggest using an Ex-PRESS mini shunt for your filtration procedure, or trabeculectomy. Placed in the sclerostomy, this small device is made of stainless steel and allows fluid to depart from the eye. Opposed to a standard trabeculectomy, the Ex-PRESS shunt can allow for a more regulated rate of fluid flow.
Relieve Your Glaucoma
Please feel free to consult with Dr. Deborah Ristvedt at Vance Thompson Vision in Alexandria, MN for your glaucoma treatment and care. Our team is nationally recognized for glaucoma research and surgery, authoring numerous book chapters and scientific articles in addition to lecturing nationally and internationally. We are committed to using the world’s most advanced technology and techniques to halt glaucoma progression so you can live a life full of sight. To set up an appointment or ask us a few questions, please contact us today.